H.O.M.E. Group Information Request
Please fill out the following to help us connect you today!
Name:
Address:
Email Address:
Home Phone:
Work Phone:
Cell Phone:
Your Age Range:
Night of the week you prefer:
Do you need childcare while at group:
Do you prefer (choose one):
Do you know of a group you would like to attend? If so, then give us the name of the leader or of the friend in that group:
Do you have a friend or spouse that you want to join a group with? If so, then please give us their name:

Email Cindy Burkhart at

H.O.M.E. Group FAQ's